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One participant in the ASHP Foundation Critical Care Traineeship shares what she’s learning

Another day and ultimately great experience! I truly understand that this program has tremendous professional advancement to offer.

I rounded today in the SICU independently of my preceptor. Full unit. Many patients with high acuity, including:

• A 43-year-old female s/p liver resection of 20cm HCC who developed hemorrhagic shock requiring multiple units of PRBC/FFP. Intubated, sedated on vasopressor agents, hepatic and renal dysfunction.
• A 56 year-old male with self-inflicted GSW to the abdomen s/p multiple abdominal surgeries secondary to many injuries, including intra-abdominal abscess. His WBC has been elevated, low-grade fever with concerns of a possible second source of infection. The plans for the patient are that he will be bronched today and we will obtain BAL cultures.

 
Although the attending did not do usual rounds (weekend dynamics…I get it!!), it was exhilarating  to be on the unit, fielding questions from the nurses, providing input and recommendations for improving patient care to the interdisciplinary team. For example, I was able make recommendations on the 56-year-old male described above to empirically add on vancomycin and inhaled tobramyin, for concerns of VAP based on the patient’s clinical picture and current guidelines.
 
In the afternoon, I spent some time on the MICU unit getting acquainted and preparing for the types of patients I would be rounding on the next day. Malar (the other Critical Care Traineeship participant) and I will be trading positions in the upcoming week to gain greater experience and understanding of patient care issues/concerns on the different ICU units.

For example, I did come across an extremely interesting patient in the MICU with acute respiratory failure, ARDS secondary to drug/substance intoxication. The patient was intubated, sedated and put on nitric oxide a few days earlier given  his poor lung function (PaO2/F102 <150). He was also put on a prone-positioning bed that I had read about in the literature but never actually seen.

It’s really amazing to see a patient in an enormous, very elaborate bed with multiple safety straps and functions to turn the patient over per protocol to improve lung oxygenation in severe ARDS.

This prone positioning is to continue (barring complications) until it is felt the patient’s oxygenation has improved sufficiently to allow the patient to remain in the supine position. It is impressive to see along with supporting medical literature that suggests early application of prone-position sessions may improve outcomes of patients with this kind of disease state. 

Ok, more to follow next time.

Look for my next post, "Day Eight," which will be posted tomorrow, Aug.20th! Also see "Day One" from Aug. 12th and “Day Four” from Aug. 15th.